Sleep Well This Summer, Part 3: Keep Your Bedroom Quiet

It’s been a while since my last entry; too much going on this summer!  I hope you all are staying cool; it’s been a scorcher throughout most of the U.S. this month.

In recent entries we tackled how to keep your bedroom dark and cool.  I’m finishing off this summer sleep writing triad today with some tips on how to keep your sleeping environment quiet during these summer months.

Summer presents some challenges to sleeping in a peaceful quiet place.  It’s light out late, it’s vacation time, the kids are out of school, and the heat’s got people a little crazy.  So there are block parties, summer traffic, teenagers out raising a ruckus in their back yards, barbecues that run late . . . you know, all the stuff that’s great fun when you’re in the fun, but not so fun when you’re in your bedroom trying to get some winks.

As I’ve mentioned before, sleeping during the summer months is best achieved if you keep your sleeping environment dark, cool, and quiet.  Here are some suggestions to make for a quiet place in which to sleep.

1.  Fix broken or uneven windows and door and window frames, basically anything that can cause a draft.  Things that leak in unwelcome air will also leak in unwanted noise.  Doing so will probably reduce your energy bills too.

2.  Fortify your windows to insulate them from noise.  Try thicker glass or double-paned glass.  A cheaper and easier alternative would be to place thick, black curtains in front of the windows.

3.  Try a little “white noise,” particularly if you live in an area in which outside noise is unavoidable (train tracks, a busy intersection, or what have you).  A fan works well, because the convective effect of the circulating air cools you down as well.

4.  If you live in an apartment, request a corner apartment farthest away from the street.  And preferably as far away from loud, selfish, obnoxious neighbors as possible.

5.  Sleep in a room closest to the center of your dwelling.  The more drywall that separates you from the outside world, and the fewer windows in the room, the quieter in general your sleeping environment will be.

6.  Sleep in the basement, if you must.  Nothing like surrounding earth to insulate you from the noise and heat in the summertime.

7.  Though earplugs may be helpful, I personally advise against this, simply because you want to be able to hear potential problems around the house:  a crying baby, for example, a fire alarm, etc.

8.  If your bed partner snores substantially, discuss this with your bed partner and consider informing his or her physician.

9.  This is embarrassingly obvious, but turn off whatever beeping, pinging, whirring, droning electronic gadgets you have in your bedroom if you possibly can.

10.  Turn off TV’s, radios, and iPods.  Many people feel like they can’t sleep without background noise from such gadgets, but let me assure you that the reason why this feels this way is because of simply habituation:  your body does not biologically require such noises, but if you’ve had some sounds in the room at night for years, it feels like you need them when you don’t.  Turn off these devices and you should fairly quickly come to enjoy the silence.

11.  Particularly if you work night shifts, have open discussions with your family and loved ones about how to keep the noise of other people from disrupting your sleep.  As with most other situations, it’s always best to communicate openly and honestly about such topics!

Enjoy the rest of our summer, everyone!  I wish you deep, comfortable sleep!

 

Sleep Well This Summer, Part 2: Keep Your Bedroom Dark

Hi, all!  This is the continuation of my short series how to sleep well during the warmer and longer days of summer.  As mentioned in Part 1, people generally find a dark, cool, quiet environment most conducive to sleep.  Today’s entry is devoted to improving your sleep by keeping your sleeping environment dark.

 

By way of background, light is an extremely potent outside influence on your “body clock,” which regulates the timing of certain biological functions of your body.  Exposure of your retinas to light stimulates a neurologic pathway through your brain, essentially telling your body clock it’s time to be awake.  As such, exposure to light shortly upon arising in the morning can cause you to feel more awake and alert, and bright light exposure late at night can cause insomnia.  Even relatively modest light can have a stimulatory effect.  It makes sense, then, that shielding your bedroom from bright light is important during the summer, when the sun often shines relatively late into the evening, carrying both light and heat into your room.

Here’s a couple of considerations to darken your room.

1.  Sleep in a room without windows.  If you can.  Basements are great for that, for example, and some of my patients simply migrate to a basement bedroom each summer to sleep better.

2.  Sleep in a room which has windows that don’t face westward.  The sun sets in the west.

3.  Cover your windows.  I recognize this seems obvious, but it’s amazing how many people sleep in bedrooms with bare windows.

4.  Cover your windows with something dark (preferably black) and thick, such as black curtains.  Venetian blinds generally don’t do a great job of shielding the room from light.

5.  Turn your bed away from your windows.

6.  Turn off all the lights and the television when you’re ready to go to sleep.  Again, I’m stating the obvious here, but many people sleep with lights and other electronics on.

7.  Turn around or turn off glowing electronics, like digital alarm clocks.  If you’re an insomniac, turning your nightstand clock around will have the added benefit of keeping you from the deadly habit of “clock-watching,” which I’ve written about in previous entries.  It would also be helpful to turn off the lights one night and simply look around the room, looking for electronic lights.  You might be surprised about how much glowing, blinking stuff coinhabits your sleeping space, from your DVR, stereo, laptop, cable box, or whatever.  Turn off or hide whatever light sources you can, even if they’re small.  Turn down brightness levels as well if possible.

8.  Reconsider your nightlight.  Some people have long slept with a nightlight without problems, but bed partners may be bothered by this.  Discuss this with your spouse or bed partner.  If a nightlight is absolutely necessary, consider getting one that can be dimmed.

9.  If necessary and if all else fails, sleep masks or even dark sunglasses can help.  Hopefully, however, you can keep your entire bedroom dark throughout the night.

Sleep well, everyone!  The third and final entry in this series:  how to keep your bedroom quiet during the summer.  Enjoy these months of warmth:  winter is coming.

It’s Not About the Nail!

In this video, a woman describes some difficulties she’s had recently:  a multitude of strange, bothersome symptoms, including problems sleeping.  Take a look.

I thank my great friend and former partner in crime, David B., for bringing this piece to my attention.  It’s absolutely hilarious, but this video short does illustrate a couple important and serious reminders for me, however.

First, for each of us, there may be times in which the underlying cause of a problem can be right under your nose (or in this case, nailed to your forehead) for ages before it’s realized.  I saw a woman in my clinic this morning, for example, for her insomnia.  She’s awakened at 3 a.m. every morning because her cat sits on her face.  She told me she then gets up to put the cat into the garage.  I asked her how often she does this.  Her answer:  “every night.”  Sooo . . . why not put the cat in the garage at the beginning of the night before bedtime?  My point is that we’re creatures of habit, and we’re used to what we’re used to.  Whether we’re talking about sleep hygiene or a nail protruding from your head, what you’re used to is your “normal.”

Second, though we docs are trained and conditioned to move quickly to act and save our patients from their medical problems, sometimes what is asked of us is to just listen.  Given the changes happening in health care at the moment, I fear that the doctor’s ability to spend the time to listen to our patients will become as extinct as the dinosaurs.  Many feel that it already is.  I hope that someday there will again be a place for more humanity in the administration of health care.

Have a great evening, everyone, and remember, “it’s not about the nail!”

Morgan Freeman Falls Asleep During an Interview

I can’t resist.

The other day actors Michael Caine and Morgan Freeman conducted a live interview with Bill Wixey and Kaci Aitchison from Q13 Fox News right here in Seattle.  The interview centered around their upcoming film, Now You See Me.  But as you now see here in this abridged clip, Mr. Freeman was having a bit of a struggle staying awake while Mr. Caine spoke.

I like in particular how he arouses briefly, nods his head slowly, as if he’s been fully attentive the entire time, and drifts back off.

Here is an online article, which includes Bill Wixey’s post-interview reaction and also the full video interview with Caine and Freeman.  It’s worth watching the entire interview here:  there is much more sleep time than what is seen in the brief clip above.

http://mynorthwest.com/76/2280849/Seattle-news-anchor-puts-Morgan-Freeman-to-sleep

Now, to be fair about this, this soporific faux pas is likely not Freeman’s “fault,” and is probably not due to boredom, as at least one journalist has suggested.  It appears that Caine and Freeman were interviewed from a studio in New York.  I’m guessing Freeman had flown from Los Angeles to New York shortly prior to the interview, and if this was the case he was probably recovering from jet lag.

Remember, there’s a 3-hour time difference between the west coast and the east coast.  Sleepwise, it’s particularly tough to go from the west coast to the east coast, because upon arrival your brain is essentially asked suddenly to go to bed earlier and awaken earlier than usual, setting you up for insomnia and sleep deprivation.  I know this from experience:  I fell asleep at my table and virtually fell out of my chair once during a loud, boisterous classic rock awards banquet shortly upon arriving in London several years ago.

Additionally, in general, the older we get, the less tolerant our bodies become to insomnia, sleep deprivation, and shifts in our usual sleep scheduling.  So I definitely empathize with our nearly 76 year-old Mr. Freeman, who was sitting in a comfortable, quiet environment during the interview, his uncooperative body clock begging for a snooze.

One final comment.  I’m often asked if you fall asleep during the day just because you’re bored.  The answer is no.  However, if you are prone to becoming excessively sleepy during the day (due to sleep deprivation, an untreated sleep disorder, or the like), then your sleepy tendencies will be more likely to express themselves in the form of falling asleep by accident when you are sedentary as compared to when you’re active.  When you’re bored you’re usually sedentary, so in that setting you’re therefore more likely to fall asleep.  This is an important distinction to make; many people don’t get evaluated for their sleep disorders because they believe that falling asleep frequently during the day is normal because they’re bored.

 

Have a good, wakeful day, everyone!

Governor Chris Christie Undergoes Weight Loss Surgery

 

Today it was announced that New Jersey Governor Chris Christie underwent lap band surgery for weight reduction in February.  Governor Christie’s longstanding struggle with his weight has been the subject of intense media scrutiny–perhaps in some cases unfairly–in recent years, but at least the publicity has brought some high-profile attention to a problem that many find difficult to discuss openly:  what to do about the American epidemic of obesity.

Bariatric surgery for weight loss has been around for a long time, but public awareness of the availability and benefits of bariatric programs has increased substantially in the past decade or so.  There are now numerous surgical techniques to modify the anatomic volume and functional volume of the stomach and surrounding gastrointestinal structures to reduce hunger, food intake volume, and therefore weight.  Historically bariatric procedures centered around the physical reduction of stomach size.  More recently, however, technological advances have allowed for many to undergo less invasive procedures, such as gastric banding (commonly known as lap banding).

 

Aggressive measures to lose weight are not just for cosmetic reasons.  Many people undergo bariatric surgery due to medical problems associated with obesity–such as diabetes and hypertension–or to reduce the likelihood of later developing obesity-associated chronic illnesses, including cardiovascular disease.  Though it is a misconception that you have to be overweight to have obstructive sleep apnea, it is true that your chances of having sleep apnea increases substantially if you’re overweight or obese.  Over the years a great many of my sleep apnea patients have undergone such gastric procedures, usually with great–and even dramatic–success.  Usually these folks experience a gradual improvement in their baseline sleep apnea as the weight loss progresses, and in some cases the sleep apnea may go away completely with sufficient loss in weight.

It’s important to know that a sleep evaluation is usually a standard, integral component in the overall assessment for one’s fitness for bariatric surgery, not only because sleep apnea is a common medical problem for overweight people, but also because sleep apnea represents a peri-operative risk, particularly following extubation while recovering from anesthesia.  Often I am called upon to evaluate a bariatric candidate’s sleep well prior to surgery.  If sleep apnea is diagnosed, treatment is initiated and continued.  In addition, the patient and the physician sleep specialist should interact regularly in the months following surgery.  If CPAP (continuous positive airway pressure) is utilized for the patient’s sleep apnea, for example, the CPAP air pressures likely will start to feel uncomfortably strong as the weight goes down, and adjustments will need to be made accordingly.  Mask and headgear fit often also require adjustments and re-adjustments.  Finally, once the weight has “plateaued” (such that no further substantial weight loss is anticipated), it’s standard to reassess the patient formally to determine the extent to which the pre-existing sleep apnea has improved or, hopefully, resolved completely.

There are many great bariatric programs around the country.  They offer hope to many people that have utilized more conservative measures to lose weight with limited success.  I wish the very best for Governor Christie.

Have a great evening, everyone!

What’s With These Night Sweats?

Many of us have experienced it before, and some of us frequently:  awakening in the middle of the night drenched in sweat.  The bed sheets are soaked through; you feel this strange, uncomfortable sensation of being hot and cold at the same time.  You may need to take a shower to wash off all the mess.  WTH?

 

There are numerous potential reasons why you might sweat substantially at night.

1.  The room’s too hot.  It’s a painfully obvious cause, but a very common cause nonetheless.  Some couples disagree about how warm or cool the bedroom should be at night; you might be surprised by how often this problem occurs, and how bitter the disagreements can become.  In addition, many people simply “run hot” at night and prefer to sleep in a very cool, or even downright cold, environment.

2.  Infections.  A whole host of different viral, bacterial, and fungal organisms, most commonly causing upper respiratory tract infections and the flu, can cause fever and sweating.

3.  An underlying medical disorder.  Conditions that may be associated with night sweats would include certain cancers, thyroid problems and other endocrine abnormalities, a few neurologic disorders, and hypoglycemia related to diabetes medications.  Some medications, such as aspirin, acetaminophen, and some antidepressants, can also be associated with night sweats in and of themselves.

4.  An underlying sleep disorder.  Obstructive sleep apnea often causes “sympathetic overactivation,” triggering constant surges of adrenalin and other hormones in your bloodstream at night, leading to sweating.  The restlessness and physical activity associated with frequent arousals due to the breathing pauses also frequently contribute to the tendency toward night sweats.

5.  You are in or approaching the “change of life.”  Those hot flashes that accompany menopause can be very bothersome at night, potentially leading to substantial sleep disruption and in some cases chronic insomnia in women.

6.  Stress.  Increased sympathetic activity may also be to blame for an association between stress and sweating at night.

7.  You just sweat a lot, and it’s not clear why.  “Idiopathic hyperhydrosis” means that you simply sweat profusely, and diagnostic testing does not reveal a specific underlying medical reason for it.

What to do about the night sweats, then, depends in large part on the underlying cause(s).  Here are some general suggestions, however.

Sleep in a cool, comfortable, dark environment.  Use bedding materials and clothing that are comfortable and that don’t trap moisture.  See your physician if there is the potential for a concern for an underlying medical problem (weight loss, substantial fatigue, and fever, for example, should prompt you to consider medical attention).  Your primary care physician should be alerted to symptoms consistent with menopause.  If you snore loudly, gasp out of sleep, have witnessed breathing pauses during sleep, and feel tired and sleepy during the day, I would recommend seeing a doc like me, someone who specializes in sleep medicine.

 

Sleepy Teen? Read On

You have a teenager in the house. He’s 15. Great kid, popular, happy, fun to be around. Problem is, recently, with several months of school under his belt, he is sleepy too, all the time, falling asleep in front of you at the dinner table.

 

Excessive daytime sleepiness is increasingly prevalent in our society. Certainly social and academic pressures represent a potential cause. I’m constantly astounded with what so many parents now expect of their children: all the activities, sports, school projects, social outings . . . it is all just so different compared to when I was young:  everything is more, crazier, faster, more wired (or wireless), more complicated. My wife and I get caught up in that as well, I’m afraid, and though we do our best to maintain a reasonable balance to our children’s lives, their after-school hours remain dominated by what feels like an endless cascade of commitments: tae kwon do, basketball, skiing, adventure guides, student council, math olympiad, latin root class, on and on. For the most part our boys enjoy these activities and participate with relish, but I really do wonder how they’re going to find the time for additional activities or expanding interests as they get closer to high school, not to mention that all-important, precious time that should be spent with family.  Back in the day, we kids had time and space to relax, even laze from time to time. Time is just such a precious commodity now for us all.

Our planet’s population continues to grow, and subsequently so do the challenges for our children, who now must compete with a huge army of peers for a limited number of scholarships, college placements, internships, jobs, and resources. It thus seems natural–crucial, even–to push your kids to do more, accomplish more, dig deeper, become exposed to more things to give them a leg up in an increasingly competitive world. However, there’s still only 24 hours in a day. So what time is often easiest to sacrifice? You guessed . . . the time usually allocated for sleep.

Adults typically need 7.5-8 hours of sleep per night to feel fully rested during the day. Teens often need more sleep than adults, such as 9 hours per night. Teenagers need proper amounts of sleep like adults do, obviously, and in fact in many ways they need their sleep even more than adults do, considering they are still growing and developing. The effects of chronic sleep deprivation for a teenager can completely wreck one’s quality of life: daytime sleepiness, tendencies to fall asleep in class, lethargy, headaches, poor academic performance, depression, social withdrawal.

There’s another important cause of daytime sleepiness in teenagers, and it’s related to their sleep schedules. Here’s a scenario many of you will know well: Sunday night your teen has terrible difficulties falling asleep, and then finds it bloody impossible to awaken early the following morning for school. There is sleepiness all day long Monday at school, and for one or two additional nights there are residual difficulties falling asleep early, compounding the sleep deprivation. You pull your hair out as you cajole and shove your teen out of bed to get to school on time. Finally Friday night comes ’round, but your teen stays up until 1 a.m., and sleeps in like the dead until noon. This happens again Saturday into Sunday, and the cycle repeats itself, with another sleepless Sunday evening. Sound familiar?

Leaving the biochemistry out of it for now, here’s the reason why this occurs. We as humans are generally creatures of habit when it comes to sleep. Our internal body clocks are designed for us to do and feel things at certain times to coincide roughly with the 24-hour period. Our circadian rhythms dictate and regulate the timing of various inner biological processes, such as when we become sleepy or when we feel awake and alert.  When it comes to sleep, many of us have a natural tendency to become drowsy just slightly longer than every 24 hours (which can help explain why many prefer to go to bed later at night as opposed to earlier).  We are usually able to stay on the 24-hour clock because of the environmental cues (like daylight) and social cues (such as work) that “entrain” us to running our sleep every 24 hours. However, adolescents are particularly susceptible to this tendency for a delay in their bedtimes, leaving them prone to feeling awake at night and making it very difficult for them to get out of bed early for school. Things then are made worse when they allow themselves to go to bed very late on weekends and sleep in on weekends, because when Sunday night rolls around it becomes very difficult to fall asleep early. This is called delayed sleep phase syndrome.

 

So, parents, though this routine of trying to get your kid to bed at night and then fighting with them to wake up in the morning gets old quickly and can drive you bats**t crazy, in many ways what you’re seeing is the manifestation of normal adolescent brain biology, essentially a clash between teen physiology and our fast and furious society’s modern expectations.  I mean, if teens didn’t have to awaken at 6 a.m. to get ready for school, but instead could awaken whenever they please, this wouldn’t be nearly as big of a deal, right?  In this real world of ours’, though, it’s still a problem that needs to be addressed:  countless report cards, interpersonal relationships, and family dynamics have been affected negatively by delayed sleep phase syndrome particularly in recent decades.  And if there is pre-existing sleep deprivation due to all the other stuff your teen does after school, this only compounds the problem, worsening daytime sleepiness and all of the sequelae from it.

There are a couple of recommendations that can help.  One is something your kid is guaranteed not to like:  wake up around the same time every morning, including on weekends.  This is generally much easier for adults than it is for teens, but if you don’t sleep in by 3-5 hours on weekends any longer, you will naturally become drowsier sooner at night (including Sundays), making it easier to achieve more sleep and awaken in time for school; you’re essentially then forcing your body clock into regularity, which can then improve the insomnia and total sleep time at night.  The key, however, is persistence, which sometimes can be lacking in some kids.  When I am counseling my teenage patients with delayed sleep phase, I basically become their coach, working to help them understand that they can do it, that they will do it, for the sanity of everyone around them, including themselves.  The other helpful management tool is bright light therapy, such as with a light box (2000-2500 lux) early in the morning, and the avoidance of bright light in the late afternoon to evening.  Certain medications may be useful in severe cases, like melatonin or modafinil, but these are teenagers we’re talking about, and my clinical practice has generally been to try to do things as naturally as possible in this setting.

Take-home message today:  help your teen get proper amounts of sleep by examining his or her bedtime schedules and discussing openly what could be modified to make everybody happier in the house.  As with everything else within the realm of parenting, love, communication, and the constant quest to understand are cornerstones in helping your adolescent achieve good sleep.

There will be more to say regarding circadian rhythm disorders in future posts.  It’s time for dinner now, though, so ’til next time . . . sleep well!